The sound of pneumonia

[tarahg]

I work on vent and trach unit and I had noticed a lady was running a temp for 3 days and her lungs sound had a slight crackle to them. Well I knew she was getting something but when I went and told resp. she immediately said it was probably pneumonia. I am newly graduated and I am 98% that in school they said the first sign of pneumonia was absent breath sounds. Can you explain what sound I would hear?

[SouthernLPN2RN, MSN, RN, APRN, NP]

tarahg said:

I work on vent and trach unit and I had noticed a lady was running a temp for 3 days and her lungs sound had a slight crackle to them. Well I knew she was getting something but when I went and told resp. she immediately said It was probably pneumonia. I am newly graduated and I am 98% that in school they said the first sign of pneumonia was absent breath sounds. Can you explain what sound I would hear?

With the crackles and temp, I'd suspect pneumonia. Absent breath sounds indicate pneumothorax/hemothorax.

[papawjohn]

Hey Taragh

The first thing to remember about breath sds is that you've gotta have air going in and out before you've got 'em. So Southernlpn is of course correct that ABSENT breath sds can be pneumo- or hemothorax. But it can also be CONSOLIDATION, where the secretions clog up or (we say) 'plug' the airways. Pneumonia is a big reason for 'consolidation'.

The second thing to remember about breath sds is that the 'pitch' of the noise is determined by the size of the airway that makes the sound. That's pretty simple isn't it? Think of musical instruments. A piccolo is tiny and makes high pitched sound. An Oboe is big and makes low pitched sounds. So if you hear what we used to call 'rales' and now call 'crackles'--you're hearing a 'fine' or 'high pitched' sound. These are made in the small airways in the bases. Usually we think of CHF when we hear rales. Why? Because usually we think of pneumonia as having a particular location. Like: Lower Left Lobe. Rales/crackles tend to be widespread.

The resp therapist was probably making a judgement based on the Pt's general status (ETTubes, Vents, Traches and such make one very vulnerable to infection of course. You can think of several ways that happens I'm sure.)

The fever was a big clue. You should also look at the most recent Chest XRay--call and get an order for one if needed. And naturally, see that appropriate cultures are done.

Keep listening!!! As you listen to hundreds of lungs and compare what you hear with what the chart and XRays tell you, it will no longer be a mysterious process. It will become like the breath sds you want to hear: CLEAR.

Papaw John

[elnski]

1st sign of pneumonia: dyspnea, tachypnea, use of accessory muscles, sputum production, cough, etc... So you would auscultate, crackles, rhonchi pleural friction rub... bloods: raised WCC and CRP, ESR..